Provider Demographics
NPI:1417017815
Name:POGET, PHILLIPPE A (PT)
Entity Type:Individual
Prefix:
First Name:PHILLIPPE
Middle Name:A
Last Name:POGET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SUSANNAH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1765
Mailing Address - Country:US
Mailing Address - Phone:423-282-9011
Mailing Address - Fax:423-722-0288
Practice Address - Street 1:2410 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1765
Practice Address - Country:US
Practice Address - Phone:423-282-9011
Practice Address - Fax:423-722-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3647095Medicaid
TN3647095Medicaid
TN3647095Medicare PIN